Pain Medication?

Hello All,
I am new here, my name is Melodie. We have 6 beautiful children already, and are expecting #7 in June of 2010. Growing up with a mother in the medical profession, I have always been one to just do as I'm told, because the Medical staff know what they're doing and what's best. My Mom was a L&D nurse for years, and moved on to NICU for the majority of her career. So this field especially, it was ingrained into me, to just listen to the Dr's and medical staff. I'm SO excited to be learning the things I am learning, since watching Ricki and Abby's video!! (Thanks so much ladies, for doing this!!!)
Right now I'm in the process of trying to figure out a birth plan. I live in a small community with no access to resources like Midwives or Doula's. And of the 2 choices for OB's in our town, I'm very blessed to have gotten in with the "Good" one. I'm a little nervous about all of this though - about whether he will be open to the things I am thinking I want to do differently with this labour - as well, I KNOW the nursing staff will not be overly supportive. They have all been there for years, and are just too set in their ways of what they think is how things should be done. Last time, I discovered, through a video a technique of simply moaning lowly through the pain of a contraction, which helps your body to relax more, and let the contraction do its job. I wish I'd known this through the others. It helped so much! But the nurse assigned to me, gave me heck for doing it and told me to stop, because I would give myself a sore throat.

Anyway - in trying to do up a birth plan...as I've never done this before without pain meds, I'm questioning whether the different meds will interrupt the "flow of hormones" etc. I really would like to try without anything this time, but I just am worried that without a strong support person, I may not be able to. I'm wondering if anyone knows what meds have the least affect on the whole process of things. There are so many options that they put out there for you, but I have no idea whether I should even consider any of them or not.

Replies to This Discussion

I've been where you are, and I understand what it's like. What helped me the most to do unmedicated birth for the first time was my doula. She gave me information as well as the physical and emotional support during labor. Check the DONA website (www.dona.org) and do a search to see if you can find any doulas in your area. Regardless, you should educate yourself as much as possible. Henci Goer's book "The Thinking Woman's Guide to a Better Birth" has a whole chapter devoted to explaining epidurals and narcotics (chapter 8). That would be a good one to read, and another good informative book is "Pregnancy, Childbirth, and the Newborn", by Simkin, Keppler, and Whalley.

If you absolutely cannot find a doula in your area, you and your husband should work together to learn comfort measures and techniques to use during labor. You can practice these during pregnancy to get yourself used to them and be able to remember what to do when you're doing the real thing. The low moaning has been incredibly helpful to me, as well as counter pressure on my hips and lower back. If you have a good friend or family member who is supportive of your wishes, you may want to ask that person to be there along with your husband to help with these things. Sometimes it takes more than one person to apply counter pressure, or someone to fill in while the other person takes a break. You and your husband can also take a childbirth education course like Hypnobabies, The Bradley Method, or Hypnobirthing, which could help prepare you very well for natural labor.

Thank you so much Cherylyn, for your words of encouragement. I have searched a couple of times for both Midwives and Doula's in my area, and the closest is in a city that is 2 hours away from me. We also have only one option for childbirth classes here, that are put on through our public health system. We took them with our first baby, and didn't find them overly helpful.
I am doing as much research as I can to learn different techniques. I also have 2 friends (too far away for them to help me though) that are certified Doula's, so I have contacted them both with a list of questions, as well as a friend here who use to be a midwife a number of years ago, before she moved here to Canada, so I have contacted her as well. I'm anxious to hear back from all of them.

I hadn't thought of even just asking a friend to be there to help and support along with my hubby. Thank you for that suggestion! I am going to put some careful consideration into this option.

Thanks for the links and the book recommendations too. I will definitely check those out.

Quick question...the counter pressure on your hips - was it on the back side of them, or on the sides?
With one of my labours, my DH couldn't press hard enough in the centre of my lower back...but only with that one labour. It didn't work at all with any of the others.

The double hip squeeze is what my husband, doula, and midwife used on me, and it can be done by one or two people. They apply direct pressure on the side of each hip. It's better if you have one person on each side, but one person can do it by pressing one hand on each side. I also found direct pressure on my sacrum (very low back, between the hips) in the middle was great. During my last birth I had my husband pressing on my sacrum and my midwife doing the double hip squeeze at the same time.

You may also want to look into online childbirth education courses. I've heard that you can do online Hypnobabies classes, and there may be others available as well.

" But the nurse assigned to me, gave me heck for doing it and told me to stop, because I would give myself a sore throat."

I'm so sorry that you were discouraged from that! That's how I got through my labors. I don't know how I could have held those moans in. And yes, I did get a sore throat the next day! But did it matter? Not in the least :-).

The other advice has been great, so I would just like to encourage you to remember, that even though you haven't gone "all natural" before, you have indeed walked the labor road SIX TIMES. It's not going to be all new, or hugely unfamiliar, it will be different but not unrecognizable. Have confidence in your abilities as a mom. If you can raise six children while growing a seventh in your belly, you are a champion and an inspiration. Be encouraged!

I am sorry your nurse didn't encourage your vocalizations. That is a wonderful tool during birth.

You may want to look into Hypnobabies, a hypnosis for childbirth program. It gives you wonderful tools to stay comfortable and calm during your birth. I used it for my last birth and it was great. You can see my birth video at www.pregnancybirthandbabies.com

I would say ditto on the support thing, but I would also say having your husband there is a big plus too. With my first two births, I had them in birth centers were the staff was wonderfully supportive. My last three where in hospitals, but they went fine. My husband and I both knew the drill by then and I usually didn't even go to the the hospital until I delivered. Something that helps with unsupportive nurses, is just assigning your husband to talk with them. Let him be the gate keeper. The nurses will get ticked off by it and think he's making all your decisions, but it will be less stressful for you. If you mentally allow yourself to accept the way the nurses are and let other people deal with them.

I would also add that some women wear themselves out in early labor (getting up to that 4 or 5 cm). I don't know how fast your labors are, but if you have an extended early labor it is best to just use distraction techniques. Watch a movie, play a game together and I really like the idea of writing notes to your baby about to be born. Distract yourself as long as possible until you can't anymore, then move into your breathing and such.

One thing that is really important is to get it in your mind that you are not going to want an epidural. I have noticed that once women decide that they are done with working through labor, then their pain gets much more unbearable. Of course you still have to be flexible at the same time:) Labor is very unpredictable. What I usually suggest is decide beforehand when you would want an epidural. For some this is before contractions even start, others decide that if they are feeling exhausted and tired, then they want the epidural. I would center that decision more around other things, though, then just being in pain.

Make sure you discuss your birth plan beforehand with your doctor. Showing it to the nurses, is something I wouldn't do. I guess I see the reaction of too many nurses when they get one. Just have your husband tell them what you want as it arises.

Just so you know, I loved my labors! Even the ones that I thought were more painful.

Thanks to everyone for your replies and your support. I'm really glad to have found a place with resources like this.

After talking more over the past couple weeks with my husband, he has decided that he wants to do whatever it takes. He's always been wonderful, but he now wants to educate himself more. I think that's exciting. I am going to let him take the lead, and just forget about what they may try to push.

I'm glad I've never opted for an epidural, but my labours were never long enough for me to really feel it was something i NEEDED. With my last baby, my sister tried to no end, to convince me that I should get one, because "WHY would you want to feel that!!" I've always felt, that as bad as it was, It wasn't all that bad. The meds that I used in the past were Demerol, Fentanil(?), and Entonox.

At this point, I just can't help but think that caving and having that Demerol to start, created the series of chain reaction...because as labour progressed, I didn't feel it as much, until the drugs wore off, and then it was so bad, I couldn't deal, so "GIVE ME MORE!!!" I really want to try and avoid any of that this time. My longest labour was my 5th - 11.5 hours. So even at that, not horrible. My quickest was 2.5 hours. Those weren't counting the early labour that I did at home, until I was sure I was really going into labour.

I've been evaluating over and over what I want to do, and what's truly important to me. This time, I want to try and avoid interventions. Not to have an IV, unless its absolutely necessary...and if they can't waiver for whatever reason, then at least the hep lock. I partly think that if there's no IV hooked up, then it may eliminate some of the temptation to just cave and ask for meds.
I don't know enough about the meds though - those 3 that I've had in the past in particular...If I feel that I just can't manage as I'd hoped, I want to know the true effects of those meds. As the Dr's and Nurses really don't give that information.
A thing with this video that really stood out to me was the point about the epidural really interfering with the natural flow of hormones.
Does anyone know if any of those drugs interfere in that way? Or what some of the possible affects are with any of them ? (Demerol, Fentanil, and Entonox) Or if there's others that are less harmful?

I shouldn't feel so scared...I know. But I know that every labour is different, and by not being prepared for my 5th, I lost all control, and I panicked. I don't ever want to be in that space again!!

I'm not sure if narcotics like Demerol, Fentinil and Entonox interfere with the labor process specifically, but they do cross the placenta and affect the baby. They generally cause babies to be sluggish, sleepy, "floppy" and it can be harder to initiate breastfeeding after the birth. Because it makes the baby sluggish it could theoretically interfere with the baby being able to do its part in moving and twisting its way out of the womb.

My 5th baby was a surprise breech, and he helped wiggle his way out. We were in the tub and after his bottom and feet were out he was kicking and twisting in the water as I pushed. When his arms were out he actually put his hands and feet on my bottom and helped push his own head out. He probably wouldn't have been able to do that if he'd been under the effects of narcotics.

Were you more scared or unprepared with your 5th because it was a longer labor? Prepare yourself mentally and emotionally for the next birth by accepting what needs to happen. What I mean by this is to trust your body and your baby in understanding that the labor will be as long as it needs to be, and you can work through it. Learning more coping techniques and comfort measures will definitely help. Good luck!

Thank you SO much for this April! I've only had a chance to read through a couple of them, but have them all bookmarked so that I can work my way through them. There's information in here that I never knew. Its raising more questions about my past medical treatment and whether certain things happened or didn't happen as a result of receiving these drugs. I know I cannot go back and change things, but I definitely can make better choices in the future.

These drugs effect the baby more than anything. And it does make them a little floppy, which can effect breastfeeding. They are usually out of the system quick, so the timing is important. If you take them right before you push, then you are going to feel them more.

One problem with the continue use of these drugs (especially Fentanyl), is that your body adjust to them. So they help great at the beginning, but the effect wears off the more you use them. You are right about how you feel like you need more when the drug wears off. You just don't give your body or your mind time to adjust. Next time I'm at work, I'll check out the drug books there for you and see about it interfering with the hormones and such.

The natural flow of hormones that occurs is a result of your bodies chemical reaction to the physiologic progression of labor. It is a very complex positive feedback loop--like a very well orachstrated dance between the sensations you are feeling and your bodies chemical (hormonal) reaction to what and how it is feeling. Anything you put in your body that alters/blocks the way your body feels and your brain interprets will affect the bodies natural feedback loop thus affecting the natural hormones that your body would normally produce in that situation.

I.E. The pain and physical stress of labor lead to the release of endorphins (many painkilling drugs are a synthetic version of these hormones and act on the same receptors in the brain). While the natural endorphins have other positive effects on your body in addition to helping with pain (feelings of euphoria and stamina) synthetic drugs don't have the same additional, beneficial effects. And since this medicine eliminates the sensations your body needs to feel to activate the release of endorphins and acts on the same receptors in the brain it does affect the "natural flow of hormones". I don't know how much or to what extent but it does have an effect.